Images in Clinical Medicine
Pseudoaneurysm of the Right Internal Thoracic Artery
N Engl J Med 2008; 358:1603April 10, 2008
- Article
A 71-year-old woman underwent successful elective mitral annuloplasty and coronary-artery bypass grafting, with a left internal thoracic artery graft to her left anterior descending coronary artery and saphenous-vein grafts to her posterior descending and first obtuse marginal arteries. Ten days later, she noticed a painful right parasternal swelling (Panel A) that increased in size over the next 48 hours, without any associated hemodynamic instability. Computed tomography of the chest was performed (Panel B). The diagnosis of a pseudoaneurysm was made. The pseudoaneurysm was suspected to have resulted from trauma to a branch of the right internal thoracic artery from one of the sternal wires used for sternotomy closure. Selective arteriography of the right internal thoracic artery revealed a feeder vessel for the pseudoaneurysm. Coils were placed, and the feeder vessel was successfully thrombosed. The pseudoaneurysm regressed completely over the next 4 weeks and had not recurred at the 6-month follow-up. Pseudoaneurysms of the internal thoracic artery are rare and have been described in the contexts of chest trauma, central venous cannulation, and chest-wall infection and after sternotomy. Of the few cases after sternotomy that have been reported, most occurred months after surgery.
Nick P. Jenkins, M.B., B.S.
Huon Gray, M.D.
Wessex Cardiac Unit, Southampton SO16 6YD,, United Kingdom
